title: Correlates of HIV-1 genital shedding in Tanzanian women.
abstract: BACKGROUND
  Understanding the correlates of HIV shedding is important to inform strategies to reduce HIV infectiousness. We examined correlates of genital HIV-1 RNA in women who were seropositive for both herpes simplex virus (HSV)-2 and HIV-1 and who were enrolled in a randomised controlled trial of HSV suppressive therapy (aciclovir 400 mg b.i.d vs. placebo) in Tanzania.
  
  
  METHODS
  Samples, including a cervico-vaginal lavage, were collected and tested for genital HIV-1 and HSV and reproductive tract infections (RTIs) at randomisation and 6, 12 and 24 months follow-up. Data from all women at randomisation and women in the placebo arm during follow-up were analysed using generalised estimating equations to determine the correlates of cervico-vaginal HIV-1 RNA detection and load.
  
  
  RESULTS
  Cervico-vaginal HIV-1 RNA was detected at 52.0% of 971 visits among 482 women, and was independently associated with plasma viral load, presence of genital ulcers, pregnancy, bloody cervical or vaginal discharge, abnormal vaginal discharge, cervical ectopy, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, an intermediate bacterial vaginosis score and HSV DNA detection. Similar factors were associated with genital HIV-1 RNA load.
  
  
  CONCLUSIONS
  RTIs were associated with increased presence and quantity of genital HIV-1 RNA in this population. These results highlight the importance of integrating effective RTI treatment into HIV care services.
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. c.tanton@ucl.ac.uk
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Jerome
authors.initials: J
authors.lastname: Le Goff
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Mary
authors.initials: M
authors.lastname: Rusizoka
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.forename: Dean
authors.initials: D
authors.lastname: Everett
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
authors.forename: Laurent
authors.initials: L
authors.lastname: Belec
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D000328:Adult; D001519:Behavior / Q000502:physiology; D002584:Cervix Uteri / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015497:HIV-1 / Q000502:physiology*; D018258:Herpesvirus 2, Human / Q000235:genetics; D006801:Humans; D012367:RNA, Viral / Q000032:analysis; D013636:Tanzania; D014621:Vagina / Q000821:virology*; D019562:Viral Load / Q000502:physiology; D017201:Virus Shedding / Q000502:physiology*
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral